Terms Of Outcomes Research Articles

Improved outcomes of ABO incompatible living donor liver transplant with biologically related donors.

Liver transplantation is considered to be the only curative treatment in decompensated liver disease. Shortage of liver allografts is a major impediment for widespread application of this procedure. ABO-incompatible grafts have been used successfully thereby increasing the LDLT donor pool. However, ABO-I liver transplantation is associated with complications like acute liver rejection, hepatic artery thrombosis and higher biliary stricture rates leading to transplant failure, re-transplantations or sepsis-related complications. Various desensitization strategies have been adopted which have improved outcomes. Biologically-related donor-recipient pairs have theoretical advantage of favourable HLA match. We have analysed the outcomes of ABO-incompatible LDLT and compared the results of HLA-matched (biologically-related) and HLA-unmatched (biologically-unrelated) donor-recipient pairs. Retrospective data of 90 cases of ABO-I liver transplant recipients: HLA matched (n=35) and HLA un-matched (n=55) for comparison of pre-operative and post-operative data. Peak bilirubin level in HLA-unmatched recipients were higher. Platelets count were lower than HLA-matched recipients (7.3mg/dL vs 8.9mg/dL). No significant difference in days-to-normal bilirubin, peak INR, hospital stay and discharge-day from transplant between both groups. Post-operatively, HLA-unmatched recipient required more pulse-steroids therapy than HLA-matched - 21/55 (38.2%) vs 11/35 (31.4%). Biliary complication and intervention were more in HLA-unmatched group (12/55, 21.8%) than HLA-matched (4/35, 11.4%). Renal complications requiring post-operative haemodialysis was more in HLA-unmatched group than HLA-matched group 9/55 (16.4%) vs 3/35 (8.6%). The incidence of vascular complications was similar. ABO-I LDLT is an effective and safe method for increasing the donor pool in absence of ABO-C liver donor. Long term outcomes of recipients with biologically-related donors are marginally better than biologically-unrelated ABO-I LDLT recipient. However, incidence of antibody-mediated graft rejection and biliary complications are more in biologically-unrelated ABO-I liver recipient.

4D transperineal ultrasound: feedback for good obstetric anal sphincter injuries reparation.

Obstetric anal injury is the main risk factor for traumatic anal, faecal and flatus, incontinence in women in reproductive age. Its recognition and good reparation are crucial for long term outcomes. We report a case of a nulliparous woman who reported a fourth-degree perineal tear after delivery. The obstetric anal sphincter injury was repaired and a four-dimensional transperineal ultrasound was performed after reparation and then one and three months after discharge. The woman did not experience any incontinence and no points of discontinuity were observed at tomographic ultrasound imaging reconstruction. In this case, 4D-TPUS was a tool in the obstetrician's hands to evaluate the surgical success of OASIS repair, which requires some expertise. 4D-TPUS ultrasound is useful and reliable during immediate puerperium and in the subsequent follow-up, giving positive feedback on the correct positioning of the stiches and on a good healing process. Further studies are needed to demonstrate this usefulness in the operators training and for improving their surgical skills.

Severe Maxillary Protrusion Treated with Surgically Assisted Rapid Maxillary Expansion

In this case, surgically assisted rapid maxillary expansion (SARME) was successfully adopted to treat a skeletal maxillary protrusion with large overjet and severe crowding. The female patient, aged 25 years and 11 months, was diagnosed with skeletal maxillary protrusion with severe crowding and excessive overjet associated with labially inclined maxillary central incisors. After achieving sufficient space for surgical incision between bilateral maxillary central incisors, the SARME was performed. A total of 8.0 mm lateral expansion of the maxilla was completed. At 48 days after surgery, the Hyrax appliance was replaced with an Anchor-Lock system used as an external surgical stent and skeletal anchorage for maxillary group distalization, and the distal movement of the maxillary molars was initiated without waiting for bone healing of the separated midpalatal suture by SARME. Twenty-five months’ treatment, including surgical preparation, achieved an acceptable and stable occlusion with adequate interincisal relationship. The occlusion was much more stable with a little relapse through more than 4 years’ retention period. In conclusion, SARME followed by the Anchor-Lock system might lead to favorable occlusal outcome in the long term without any relapses.

Availability and pricing of insulin and related diagnostics in South Africa.

In South Africa (SA), most patients rely on the government for free healthcare. Some choose to subscribe to a medical insurance scheme. If insulin is unavailable in government or otherwise unaffordable, non-adherence may occur, which can increase complications of the disease. Data on availability and pricing of insulin and related diagnostics was collected from SA pharmacies via an online survey. Co-payments levied on insulin by the biggest medical aids were extracted from formularies. Affordability of these items was then assessed. An adapted methodology from the World Health Organization/Health Action International tool was used. There was fairly high availability of insulin in the public sector, with the exception of long-acting insulin which respondents claimed was difficult to find; however, long-acting insulin glargine was available in most private sector pharmacies. Point-of-care (POC) blood glucose testing was free in the public sector but offered in only 31.25% of pharmacies. Patients pay a minimum of USD 40.4 (over 3 days' wages for the lowest paid government worker (LPGW)) for a months' supply of the cheapest insulin, needles and test strips. Insulin in SA was cheaper than 5 other countries, except Australia. Overall, there is a good availability of insulin and related diagnostics in SA. Even though insulin is cheaper than other countries, it is unaffordable to the LPGW. This highlights the importance of ensuring a constant availability of insulin in the free public sector. Whilst human insulins are cheaper than newer analogue insulins and SA faces cost constraints, important variables in favour of newer insulins, such as ease-of-use, long term outcomes and value should be considered when treatment guidelines are updated. Annual POC testing should be available and offered free to all patients to detect diabetes early.

Hospital-Treated Infections and Risk of Disability Worsening in Multiple Sclerosis.

To investigate the association between infections and disability worsening in people with multiple sclerosis (MS) treated with either B-cell depleting therapy (rituximab) or interferon-beta/glatiramer acetate (IFN/GA). This cohort study spanned from 2000 to 2021, using data from the Swedish MS Registry linked to national health care registries, comprising 8,759 rituximab and 7,561 IFN/GA treatment episodes. The risk of hospital-treated infection was estimated using multivariable Cox models. The association between infections and increase in Expanded Disability Status Scale (EDSS) scores was assessed using a doubly robust generalized estimating equations model. Additionally, a piece-wise exponential model analyzed events of increased disability beyond defined cut-off values, controlling for relapses, and MRI activity. Compared with IFN/GA, rituximab displayed increased risk of both inpatient- and outpatient-treated infections (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.50-2.90 and HR, 1.37; 95% CI, 1.13-1.67, respectively). An inpatient-treated infection was associated with a 0.19-unit increase in EDSS (95% CI, 0.12-0.26). Degree of worsening was greatest for progressive MS, and under IFN/GA treatment, which unlike rituximab, was more commonly associated with MRI activity. After controlling for relapses and MRI activity, inpatient-treated infections were associated with disability worsening in people with relapsing-remitting MS treated with IFN/GA (HR, 2.01; 95% CI, 1.59-2.53), but not in those treated with rituximab. Compared to IFN/GA, rituximab doubled the infection risk, but reduced the risk of subsequent disability worsening. Further, the risk of worsening after hospital-treated infection was greater with progressive MS than with relapsing-remitting MS. Infection risk should be considered to improve long term outcomes. ANN NEUROL 2024.

Hospital-Treated Infections and Risk of Disability Worsening in Multiple Sclerosis.

To investigate the association between infections and disability worsening in people with multiple sclerosis (MS) treated with either B-cell depleting therapy (rituximab) or interferon-beta/glatiramer acetate (IFN/GA). This cohort study spanned from 2000 to 2021, using data from the Swedish MS Registry linked to national health care registries, comprising 8,759 rituximab and 7,561 IFN/GA treatment episodes. The risk of hospital-treated infection was estimated using multivariable Cox models. The association between infections and increase in Expanded Disability Status Scale (EDSS) scores was assessed using a doubly robust generalized estimating equations model. Additionally, a piece-wise exponential model analyzed events of increased disability beyond defined cut-off values, controlling for relapses, and MRI activity. Compared with IFN/GA, rituximab displayed increased risk of both inpatient- and outpatient-treated infections (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.50-2.90 and HR, 1.37; 95% CI, 1.13-1.67, respectively). An inpatient-treated infection was associated with a 0.19-unit increase in EDSS (95% CI, 0.12-0.26). Degree of worsening was greatest for progressive MS, and under IFN/GA treatment, which unlike rituximab, was more commonly associated with MRI activity. After controlling for relapses and MRI activity, inpatient-treated infections were associated with disability worsening in people with relapsing-remitting MS treated with IFN/GA (HR, 2.01; 95% CI, 1.59-2.53), but not in those treated with rituximab. Compared to IFN/GA, rituximab doubled the infection risk, but reduced the risk of subsequent disability worsening. Further, the risk of worsening after hospital-treated infection was greater with progressive MS than with relapsing-remitting MS. Infection risk should be considered to improve long term outcomes. ANN NEUROL 2024.

Are short term outcomes superior following total knee arthroplasty when infra-patellar fat pad is resected? A systematic review and meta-analysis.

Data suggests the infra-patellar fat pad (IPFP) is resected in the majority of total knee arthroplasty cases. Current literature suggests there may be scope for increasing preservations rates. A systematic review and meta-analysis of available literature was performed to assess if resection of IPFP resulted in superior patient outcomes. Scopus, PubMed, Cochrane, Embase and CINAHL were systematically searched in February 2024 for articles of relevance and meta-analysis conducted. A standardized mean difference and confidence interval of 95% was calculated. An odds ratio was calculated for all included datasets. Heterogeneity was assessed for using the I2 statistic. Thirteen studies were included within this review. IPFP resection shortened the patella tendon at 6 months post-operatively (OR, 0.07; 95% CI, 0.02-0.12, P = 0.006). Results favoured preservation at 12 months post-operatively (OR, 0.02; 95% CI, -0.02 to 0.06, P = 0.32). Oxford Knee Society (OKS) results statistically favoured preservation at 6 months (OR, 1.57; 95% CI, 0.74-2.39, P = 0.0002). Findings at 12 months favoured resection (OR, -0.49; 95% CI, -5.39, 4.41, P = 0.84). Resection increased anterior knee pain at 6-12 months post-operatively (OR, 1.45; 95% CI, 1.12-1.89, P = 0.005). Combined subgroup analysis of flexion favoured resection (OR, -2.15; 95% CI, -6.52 to 2.22, P = 0.34). OKS and patella tendon length results favoured preservation at 6 months however did not reach minimal clinically important difference. Combined subgroup analysis of flexion did not yield a statistically significant result. Rates of anterior knee pain at 6-12 months favoured preservation.

Are short term outcomes superior following total knee arthroplasty when infra-patellar fat pad is resected? A systematic review and meta-analysis.

Data suggests the infra-patellar fat pad (IPFP) is resected in the majority of total knee arthroplasty cases. Current literature suggests there may be scope for increasing preservations rates. A systematic review and meta-analysis of available literature was performed to assess if resection of IPFP resulted in superior patient outcomes. Scopus, PubMed, Cochrane, Embase and CINAHL were systematically searched in February 2024 for articles of relevance and meta-analysis conducted. A standardized mean difference and confidence interval of 95% was calculated. An odds ratio was calculated for all included datasets. Heterogeneity was assessed for using the I2 statistic. Thirteen studies were included within this review. IPFP resection shortened the patella tendon at 6 months post-operatively (OR, 0.07; 95% CI, 0.02-0.12, P = 0.006). Results favoured preservation at 12 months post-operatively (OR, 0.02; 95% CI, -0.02 to 0.06, P = 0.32). Oxford Knee Society (OKS) results statistically favoured preservation at 6 months (OR, 1.57; 95% CI, 0.74-2.39, P = 0.0002). Findings at 12 months favoured resection (OR, -0.49; 95% CI, -5.39, 4.41, P = 0.84). Resection increased anterior knee pain at 6-12 months post-operatively (OR, 1.45; 95% CI, 1.12-1.89, P = 0.005). Combined subgroup analysis of flexion favoured resection (OR, -2.15; 95% CI, -6.52 to 2.22, P = 0.34). OKS and patella tendon length results favoured preservation at 6 months however did not reach minimal clinically important difference. Combined subgroup analysis of flexion did not yield a statistically significant result. Rates of anterior knee pain at 6-12 months favoured preservation.

Once or consecutive administration of inhaled salbutamol in children with acute asthma exacerbation: Is an additional dose beneficial?

Although international guidelines generally recommend the back to back use of short-acting β-agonizts (SABA) within a short time in the management of acute wheezing in children with asthma, there is still uncertainty in the evidence of short term outcome. Thus, this study aimed to investigate the efficacy of back to back and single use of inhaled SABA by lung function testing. This was a prospective, double-blinded, placebo controlled study conducted in children ≥6 years of age with a history of asthma. Children who presented with an acute asthma exacerbation (AAE) with a forced expiratory volume in 1 s (FEV1) between 40% to 60% were enrolled in the study if they had a first dose to SABA response of FEV1 ≥ 12%. All children were then randomly assigned either to receive two additional doses of inhaled SABA (300 µg per dose) or placebo. Spirometric analysis included forced vital capacity (FVC), FEV1, FEV1/FVC, PEF, and FEF25-75 at baseline, 15, 30, and 45 min for each group. Oxygen saturation and heart rate were monitored during the study period. A total of 93 patients (inhaled SABA group; n = 48 vs. placebo group; n = 45) out of 110 enrolled patients completed the study. Baseline demographic characteristics of patients include age, gender, age of diagnosis, parental asthma, history of allergic rhinitis and atopic dermatitis, current asthma treatment, IgE and skin prick test were similar among groups. (p > .05) When lung function parameters were compared at each time interval during the study period, there were no statistical significance found in FVC, FEV1, FEV1/FVC, PEF and forced expiratory flow between 25% and 75% (FEF25-75) among groups. (p > .05) There were also no differences between groups for changes in heart rate and oxygen saturation. (p > .05) CONCLUSION: A single dose of inhaled SABA provides similar short term bronchodilator effect as back to back administration of inhaled SABA in children with AAE who showed an initial response to SABA of FEV1 ≥ 12%.

Short- and long- term outcomes of transcatheter ventricular septal defect closure using different devices: A single center experience in pediatric and adult patients.

Short- and long- term outcomes of transcatheter ventricular septal defect closure using different devices: A single center experience in pediatric and adult patients.

Synergistic anticancer effects of omega-3 fatty acids (EPA/DHA) and anticancer drug Doxorubicin against human lung adenocarcinoma

Single agent therapy in the treatment of cancer did not provide satisfactory clinical outcome in a long term due to drug resistance, cumulative toxicity and suboptimal efficacy. Therefore, combination therapies are apt to improve the quality of life in patients. In the present study, combinatorial effect of EPA and/or DHA with doxorubicin (Dox) was evaluated for their potential synergistic effect on human lung adenocarcinoma (A549) cells. The respective IC50 values obtained for EPA, DHA and Dox were 170, 140 and 2.5 μmol/L and thus EPA and DHA were separately combined with Dox at constant ratio of 68:1 and 56:1 respectively, depending on the ratio of their IC50 values. Different combinations of drugs revealed dose-dependent inhibition of cell viability and IC50 values were reduced to nearly 3-fold (58.75 μmol/L) and 4.5-fold (31.5 μmol/L) in EPA-Dox and DHA-Dox combination respectively. Combination index (CI) revealed strong synergism (CI < 0.5) in DHA-Dox (0.49) and moderate synergism (CI > 0.5) in EPA-Dox (0.79) at 0.5 Fa (Fraction affected), which is further confirmed by dose reduction index and isobologram. The mechanisms underlying synergistic interactions involve intracellular ROS generation and MMP depolarisation which causes changes in the cell morphology viz. Nuclear fragmentation/condensation, membrane blebbing and early/late apoptotic cells. Moreover, cell cycle arrest was observed at the S and G2/M phase, with more prominent effect in G2/M phase. No toxicity was imposed on non-cancerous HEK-293 T cells. These findings suggest that EPA-Dox and DHA-Dox could be explored further for animal studies and clinical trials for lung adenocarcinoma treatment.

Novel MAGIC composite scores using both clinical symptoms and biomarkers best predict treatment outcomes of acute GVHD

Acute graft-vs-host disease (GVHD) grading systems that use only clinical symptoms at treatment initiation such as Minnesota risk identify standard and high risk categories but lack a low risk category suitable to minimize immunosuppressive strategies. We developed a new grading system that includes a low risk stratum based on clinical symptoms alone and determined whether the incorporation of biomarkers would improve the model’s prognostic accuracy. We randomly divided 1863 patients in the Mount Sinai Acute GVHD International Consortium (MAGIC) who were treated for GVHD into training and validation cohorts. Patients in the training cohort were divided into 14 groups based on similarity of clinical symptoms and similar NRM; we used a classification and regression tree (CART) algorithm to create three Manhattan risk groups that produced a significantly higher area under the receiver operating characteristic curve (AUC) for 6-month NRM than the Minnesota risk classification (0.69 vs. 0.64, P=0.009) in the validation cohort. We integrated serum GVHD biomarker scores with Manhattan risk using patients with available serum samples and again used a CART algorithm to establish three MAGIC composite scores that significantly improved prediction of NRM compared to Manhattan risk (AUC, 0.76 vs. 0.70, P=0.010). Each increase in MAGIC composite score also corresponded to a significant decrease in day 28 treatment response (80% vs. 63% vs. 30%, P<0.001). We conclude that the MAGIC composite score more accurately predicts response to therapy and long term outcomes than systems based on clinical symptoms alone and may help guide clinical decisions and trial design.

FRACTION: protocol of a phase II study of Fedratinib and Nivolumab combination in patients with myelofibrosis and resistance or suboptimal response to JAK-inhibitor treatment of the German MPN study group (GSG-MPN).

Development of Janus-kinase (JAK) inhibitors has revolutionized the therapeutic landscape for patients with myeloproliferative neoplasia (MPN). Following approval of the first JAK1/2-inhibitor Ruxolitinib, symptoms of this inflammatory disease, characterized by splenomegaly, release of inflammatory cytokines and appearance of thrombosis, could be effectively reduced for the first time. However, JAK-inhibitor treatment is limited in several aspects: 1) duration of response: 3years after initiation of therapy more than 50% of patients have discontinued JAK-inhibitor treatment due to lack of efficacy or resistance; 2) reduction of disease burden: while effective in reducing inflammation and constitutional symptoms, JAK-inhibitors fail to reduce the malignant clone in the majority of patients and therefore lack long-term efficacy. Early clinical trials for patients with myelofibrosis (MF) have tried to address these issues for patients with suboptimal response to Ruxolitinib therapy while combination therapies with Fedratinib are rare. Recent reports provided first evidence on how the JAK2-V617F mutated myeloid cells may influence T-cell responses. JAK2-V617F promoted the synthesis of PD-L1 in MPN cells leading to limited anti-neoplastic T-cell responses, metabolic changes in T-cells and eventually JAK2-V617F-driven immune-escape of MPN cells. These findings may facilitate the use of immunotherapeutic approaches for JAK-mutated clones. Immune checkpoints refer to a variety of inhibitory pathways that are crucial for maintaining self-tolerance and modulating the duration and amplitude of physiological immune responses in peripheral tissues in order to minimize collateral tissue damage. The FRACTION study is a single arm, open label Phase II trial investigating the combination of Fedratinib with the PD-1 inhibitor Nivolumab in patients with myelofibrosis and suboptimal or lack of response to JAK-inhibitor therapy. Over a 12months period the trial assesses longer term outcomes, particularly the effects on clinical outcomes, such as induction of clinical remissions, quality of life and improvement of anemia. No prospective clinical trial data exist for combinations of JAK- and immune-checkpoint-inhibitors in the planned MF study population and this study will provide new findings that may contribute to advancing the treatment landscape for MF patients with suboptimal responses and limited alternatives.

1147 Long Term Outcomes Following Combined Liver-Kidney Transplantation

Abstract Aim Combined liver kidney transplant (CLKTx) is the mainstay of treatment for concurrent liver failure and end stage renal failure. The use of CLKTx has increased markedly since the introduction of the MELD (Model for End Stage Liver Disease) score for liver allocation. In this study we examined the long-terms outcomes of 25 years of CLKTx in our centre. Method From a database of all transplants from 1997 – 2022, 158 recipients of CLKTx were identified. Primary outcomes of interest were mortality and graft failure. Data was analysed in R studio and GraphPad prism. Results Overall patient survival was 89% at 1 year, 87% at 2 years, 81% at 5 years, 72% at 10 years and 50% at 20 years. The 20-year patient survival with a pre-transplant (preTx) MELD of &amp;lt;20 was 52%, with a preTx MELD of &amp;gt;20 associated with significantly lower 20-year patient survival of 26% (P&amp;lt;0.05). Death censored (dc) liver graft survival was 99% at 1 year, 98% at 2 years, 97% at 5 years and ten years, and 88% at 25 years. A donor age of &amp;lt;40 showed 20-year liver graft survival (dc) of (100%), which was significantly greater than the donor age &amp;gt;40 group (72%, P&amp;lt;0.05). Death censored kidney graft survival was 96% at 1 year, 95% at 2 and 5 years, 92% at ten years and 84% at twenty years post Tx. Conclusions We report favourable long-term outcomes following 25 years of CLKTx. Predictors for better long-term patient and graft survival include pre transplant MELD score and donor age.

Shaped by boom-and-bust: a history of the Canadian mining industry since 1859

ABSTRACT This article is concerned with the historical evolution of the mining industry in Canada since 1859. The focus is directed on changes that occurred in the industry and allows for the identification of four distinct mining regimes. These regimes are defined using the Regulation Theory, which connects conditions of production, technical progress, financial structures, and social relations. The identification of regimes gives a portrait of continuity and change in the industry. Continuity is present in the active role of the state, the legal framework based on Free Mining Principle and persistent speculation in the industry. Change is illustrated in price cycle, labour share and technological innovation. Interestingly, through time, price cycles have very different outcomes in financial and real economic terms. The most recent upswing in the late 1990s resulted in a punctual increase of financial assets but no significant increase in employment. Through this discussion, it becomes evident that the mechanisms underlying continuity and change have implications on the nature of state intervention and on the distribution of power between the corporate and regional actors like the workers and indigenous communities.

Shaped by boom-and-bust: a history of the Canadian mining industry since 1859

ABSTRACT This article is concerned with the historical evolution of the mining industry in Canada since 1859. The focus is directed on changes that occurred in the industry and allows for the identification of four distinct mining regimes. These regimes are defined using the Regulation Theory, which connects conditions of production, technical progress, financial structures, and social relations. The identification of regimes gives a portrait of continuity and change in the industry. Continuity is present in the active role of the state, the legal framework based on Free Mining Principle and persistent speculation in the industry. Change is illustrated in price cycle, labour share and technological innovation. Interestingly, through time, price cycles have very different outcomes in financial and real economic terms. The most recent upswing in the late 1990s resulted in a punctual increase of financial assets but no significant increase in employment. Through this discussion, it becomes evident that the mechanisms underlying continuity and change have implications on the nature of state intervention and on the distribution of power between the corporate and regional actors like the workers and indigenous communities.

CD34+ Hematopoietic Stem Cell Count as a Novel Predictor of Vascular Event in Sickle Cell Disease Patients

Abstract Background Sickle cell disease (SCD) is one of the most common genetic disorders, it not only has hematological pathophysiological consequences, but also has systemic pathological manifestations such as vascular events (VEs). Prior studies have described that VEs are associated with poor outcomes in the short term and decreased quality of life in patients over the long term. There is no standardized method for predicting vascular injury in Sickle cell disease patients. Aim of the Work Our aim is to evaluate circulating CD34 as a novel predictive marker of occurrence of vascular event in Children with Sickle Cell Disease in their steady state and relate levels to severity of VEs in the following 6 months. Patient and Methods This study was an exploratory study, conducted at Pediatrics Hematology- Oncology Unit at Ain Shams University Children’s Hospital, where 50 children with sickle cell disease were enrolled at their steady state (defined as 2 months free from any Vascular Event prior to the study), aged 6 months - 16 years. Flow cytometry was done for quantification of circulating CD34+ at inclusion and compared to age and sex matched control and patients were followed up for 6 months for vascular events. Results There is statistically significant higher level of CD34+ among SCD patients compared to age and sex matched control with p value &amp;lt; 0.001.Circulating CD34+ showed significantly higher level in patients who developed systemic vascular events after 6 months of follow up with p value 0.022. There was no statistically significant correlation between circulating CD34+ and severity of peripheral vascular events (or any need for hospitalization) on follow up. Conclusion CD34+ cell count at steady state may be a promising biomarker of further vascular event in children with SCD.

P-724 Long-term health outcomes of 19 years follow-up of mothers conceived after oocyte donation based on the registry of a large healthcare organization

Abstract Study question Short term outcomes of oocyte donation (OD) pregnancies are known. Yet, long term effect of OD pregnancies on mother’s health are lacking. Summary answer Comparing women after OD pregnancies to spontaneous pregnancies or nulliparous women, a higher risk of thyroid diseases was found (1.41, p &amp;lt; 0.0001 and 2.13, p &amp;lt; 0.0001, respectively) What is known already Short term outcomes of oocyte donation pregnancies show increased risk of placental disease and pregnancy-related hypertensive disorders. Study design, size, duration This retrospective cohort study, conducted from 2000 to 2018, utilized the computerized records of a major healthcare provider. It compared the demographic data and long-term health outcomes of mothers who had undergone OD pregnancies with three groups: In Vitro Fertilization using autologous oocytes, spontaneously pregnancies, and nulliparous women. Participants/materials, setting, methods The study tracked the onset of chronic diseases from the date of delivery to the diagnosis of any chronic disease. The risk of various diseases and mortality among these groups was assessed using a Cox proportional hazards model. This model adjusted for variables such as age at the index date, number of children, body mass index (BMI), and smoking habits. Statistical significance was determined using two-sided p-values, with a threshold of P &amp;lt; 0.05. Main results and the role of chance Regarding long-term outcomes, no difference was found between mothers after oocyte donation comparted to mothers after IVF (See table 1).. When comparing oocyte donation pregnancies to mothers after spontaneous conception, mothers after oocyte donation had less lower prevalence of rheumatology diseases (6% vs 8.9%) and more higher prevalence of thyroid diseases (21.9% vs. 17.6%). However, in cox regression, taking into account smoking, number of birth and mom’s age, we only found a higher risk of thyroid diseases (OD 1.41, p &amp;lt; 0.0001). Lastly, oocyte donation pregnancies compared to nulliparous had more thyroid diseases (21.9% vs. 6.7%, p &amp;lt; 0.001), also in cox regression (OD 2.13, p &amp;lt; 0.0001) Limitations, reasons for caution The temporal aspect of chronic disease diagnosis; a diagnosis made at a specific point does not preclude the presence of the disease at an earlier time. Also, the infrequency of some conditions within our study population could have reduced the statistical power to detect differences or associations. Wider implications of the findings The longer-term health outcome for women conceiving after OD is reassuring, and is very similar to that of IVF children and naturally conceived children, exempt for higher risk of thyroid disease. The main recommendation should be a yearly surveillance of thyroid function. Trial registration number 0046-18-BBL

Central Hepatectomy versus Major Hepatectomy for Patients with Centrally Located Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract Background Hepatocellular carcinoma (HCC) is the fifth-most common cancer globally and the third highest cause of cancer-related death exceeded only by cancers of the lung and stomach. It is estimated that 782,000 new cases are diagnosed with HCC annually and 600,000 die of this tumor globally each year. Therapeutic treatment modalities are available for patients with local disease including ablation, liver resection, and liver transplantation (LT). However, for those with respectable tumor and without an underlying liver disease, liver resection offers the best treatment. Aim of the Work The aim of this meta-analysis was to compare the short- and long- term outcomes including overall survival, recurrence rate and complications between patients treated with CH and patients treated with hemi-/extended hepatectomy for those with centrally located HCC. Patients and Methods A systematic review and meta-analysis, PubMed / MEDLINE, Scopes, Web of science, and the Cochrane Library were searched for data from inception to 1 April, 2022 with the following terms: major hepatectomy and Mesohepatectomy or central Hepatectomy and hepatocellular carcinoma. More searches by Google Scholar have been used to supplement the search with the sites mentioned above. according to the eligibility process. Abstract-based eligibility studies were obtained, and the manuscripts were fully reviewed. Report bibliographies that meet the eligibility criteria were reviewed for further studies. Results Our meta-analysis showed that the overall incidence of complications was comparable between the two modalities. However, on one hand, the incidence of post-operative liver cell failure was significantly higher in those who underwent major hepatectomy. This could be attributed to the fact that major hepatectomy is associated with the removal of 60–85% of liver parenchyma.6,7 On the other hand, a higher incidence of biliary fistula was detected for those who underwent central hepatectomy. Conclusion This study showed no significant difference in the short and long term survival and recurrence between CH and MH for CL-HCC. However, CH is associated with greater future remnant liver volume that decrease the incidence of LCF and provides more opportunities for a repeat hepatectomy after tumor recurrence.

Pericatheter leak associated with earlier peritoneal dialysis initiation does not influence long term outcomes.

Pericatheter leak associated with earlier peritoneal dialysis initiation does not influence long term outcomes.